This edition of Health at a Glance introduces a chapter on access to health care, building on recent OECD work in this area (de Looper and Lafortune, 2009). Ensuring adequate access to essential health care services on the basis of individual need is an important health policy goal in all OECD countries. Monitoring health care access is, therefore, an important dimension in assessing the performance of health care systems.

Most OECD countries aim to provide equal access to health care for people in equal need. One method of gauging equity of access to services is through assessing reports of unmet needs for health care for some reason. The problems that patients report in getting care when they are ill or injured often reflect significant barriers to care.

Health care coverage promotes access to medical goods and services, providing financial security against unexpected or serious illness, as well as improved accessibility to treatments and services (OECD, 2004c). Total population coverage (both public and private) is, however, an imperfect indicator of accessibility, since this depends on the services included and on the degree of cost-sharing applied to those services.

Financial protection through public or private health insurance substantially reduces the amount that people pay directly for medical care, yet in some countries the burden of out-of-pocket spending can still create barriers to health care access and use. Households that have difficulties paying medical bills may delay or forgo needed health care (Hoffman et al., 2005; May and Cunningham, in Banthin et al., 2008). On average across OECD countries, 18% of health spending is paid directly by patients (see Indicator 7.6 “Financing of health care”).

Access to medical care requires an adequate number and proper distribution of physicians across the country. Shortages of physicians in a geographic region can lead to increased travel times for patients and higher caseloads for doctors, which may result in increased waiting times to receive care. Measuring disparities in the “density” of physicians among regions within the same country gives some indication of the accessibility of doctor services. Regions, however, may contain a mixture of urban and rural populations, so that although a region may have high physician density, persons living in geographically remote areas of that region may still face long travel times to receive medical care. In addition, the services that physicians offer should match need, whether these are for GPs or specialists.

Measuring rates of health care utilisation, such as doctor consultations, is one way of identifying whether there are access problems for certain populations. Difficulties in consulting doctors because of excess cost, long waiting periods or travelling time, lack of knowledge or incentive may lead to lower utilisation, and in turn to poorer health status and increased health inequalities.

Dental caries, periodontal (gum) disease and tooth loss are common problems in OECD countries, variously affecting almost all adults and 60-90% of school children (see Indicator 1.10 “Dental health among children”). Despite great improvements problems persist, occurring most commonly among disadvantaged and low income groups. In the United States for example, almost 50% of low income persons aged 20-64 years had untreated dental caries in 2001-04, compared with only 20% of high income persons (NCHS, 2009). In Finland, onequarter of adults with lower education were found to have six or more missing teeth, while less than 10% of those with higher education had the same amount of tooth loss (Kaikkonen, 2007).

Cancer is the second most common cause of death in OECD countries, responsible for 27% of all deaths in 2006. Among women, breast cancer is the most common form, accounting for 30% or more of new cases each year and 16% of cancer deaths in 2006. Cervical cancer accounts for an additional 5% of new cases, and 3% of female cancer deaths (see Indicator 1.5 “Mortality from Cancer”).